Bleeding complications after dual antiplatelet therapy with ticagrelor versus dual antiplatelet therapy with clopidogrel-a propensity-matched comparative study of two antiplatelet regimes in off-pump coronary artery bypass grafting.

Content Provider	Europe PMC
Author	Varma, Praveen Kerala Ahmed, Hisham Krishna, Neethu Jose, Rajesh Gopal, Kirun Mathew, Oommen Plavannal Jayant, Aveek
Abstract	Purpose Ticagrelor combined with aspirin had shown better saphenous vein graft patency than aspirin with clopidogrel after off-pump coronary artery bypass grafting. However, the safety of this drug in regard to bleeding complications remains unknown. The aim of our study was to assess the bleeding complications of dual antiplatelet therapy with aspirin and ticagrelor compared with aspirin and clopidogrel within the first 3 months after off-pump surgery. Methods Three hundred eighty-two consecutive patients who were prescribed aspirin with ticagrelor (ticagrelor group) were compared with 660 patients who received aspirin and clopidogrel (clopidogrel group). After propensity matching, 144 patients in each group were compared for bleeding events and major adverse cardiac and cerebral events. Major bleeding was defined as composite outcome of re-exploration for bleeding, any fatal bleeding, intracranial bleeding, and any bleeding requiring hospitalization. Results Patients in the ticagrelor group had more incidence of re-exploration for bleeding (p = 0.042), pericardial effusion requiring drainage (p = 0.007), readmissions (p < 0.01), gastrointestinal bleeding (p = 0.01), and major bleeding (5.8% vs. 2.1%, p < 0.01, OR 2.8 (1.43–5.58)). After propensity analysis, gastrointestinal bleed (p = 0.024), major bleeding (7.6% vs.1.4%, p < 0.001, OR 5.8 (1.28–26.97)), length of ICU stay (p = 0.039), and readmissions (p = 0.003, OR 11.83 (1.51–92.86)) were more in the ticagrelor group. Major adverse cardiac and cerebral events were similar between the groups. Conclusion Dual antiplatelet therapy with aspirin and ticagrelor increased gastrointestinal bleeding events, major bleeding events, and readmission rates compared with aspirin and clopidogrel after off-pump coronary artery bypass grafting.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7778642&blobtype=pdf
ISSN	09709134
Volume Number	37
DOI	10.1007/s12055-020-01052-6
PubMed Central reference number	PMC7778642
Issue Number	1
PubMed reference number	33442205
Journal	Indian Journal of Thoracic and Cardiovascular Surgery [Indian J Thorac Cardiovasc Surg]
e-ISSN	09737723
Language	English
Publisher	Springer Singapore
Publisher Date	2020-10-07
Publisher Place	Singapore
Access Restriction	Open
Rights License	© Indian Association of Cardiovascular-Thoracic Surgeons 2020
Subject Keyword	Dual antiplatelet therapy Bleeding Ticagrelor Clopidogrel Off-pump CABG CABG OPCAB
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine